The three biomarkers evaluated in o

The three biomarkers evaluated in our study were conventionalindicators that have been previously used to monitor occupationalexposure to various hazardous materials. To exclude the effect ofother confounding factors on biomarkers, the age, gender, BMI,smoking and smoked food habits of participations were appropriately balanced in the exposed and control groups. In this study,oxidative DNA damage, in the form of 8-OHdG levels, was elevated in PIVAS workers exposed to ADs. Huang et al. previouslysuggested that oxidative DNA damage in PIVAS workers might becorrelated with contamination of PPE and pill exposure experience[11]. Numerous studies have indicated that elevated levels of urinary 8-OHdG is a risk factor for cancer, atherosclerosis and someother diseases [15,23]. Chromosomal aberrations, widely used as abiomarker in subjects occupationally exposed to cytotoxic drugs[24], results in increased peripheral blood lymphocytes apoptosis, and is related to an increased incidence of cancer [25,26].Our study found that the apoptosis rate of peripheral blood lymphocytes increased with increasing exposure time to ADs in the exposedpopulations. Similarly,urinarymutagenicity increasedsignificantly in nurses who handled cytostatic agents [18]. However,another report denied that there was a higher mutagenic activityin urine from pharmacists admixing anticancer agents [27]. Theresults in our study revealed an increased mutagenic activity forPIVAS workers exposed to ADs as compared to those unexposedcontrols.